ADJUNCTIVE CORTICOSTEROID-THERAPY FOR TUBERCULOSIS - A CRITICAL REAPPRAISAL OF THE LITERATURE

An extensive, although largely forgotten, literature addresses the uti lity of adjunctive corticosteroid therapy in the management of tubercu losis. Corticosteroid therapy probably improves neurological outcomes of, and decreases mortality due to, tuberculous meningitis of moderate severity, Although therapy for tuberculous pericarditis is simplified (with less need for operative intervention) by adjunctive corticoster oid administration and there are fewer deaths, the incidence of subseq uent constriction is not changed. The signs and symptoms of typical re activation tuberculous pneumonia, tuberculous pleurisy, and probably p rimary tuberculous disease (with lymphadenopathy) seem to decrease rap idly with corticosteroid therapy, although no differences in final out comes have been observed. Corticosteroid regimens used in most studies varied greatly in duration and dosage and generally caused significan t side effects, Corticosteroids do not appear to diminish the efficacy of adequate antimycobacterial therapy, Adjunctive corticosteroid ther apy appears to offer significant short-term but (other than for tuberc ulous meningitis and effusive pericarditis) minimal long-term benefit for patients with tuberculosis.